More on how doctors use iPhones, other smartphones

Thanks to devices such as the Apple iPhone, doctors, nurses and other practitioners now have one device for paging, voice recording, accessing patient records and drug interaction information -- and, for those brave enough to take on tiny or virtual keyboards, engaging in rudimentary clinical data entry.

And why not? A 2009 Manhattan Research LLC study found that 64% of doctors use iPhones or other smartphones, and that number will likely rise to 81% by 2012.

The BlackBerry, iPhone and, to a lesser extent, the Palm Pre and Google Android offer the hardware. On the software side, it’s not just basement programmers creating health care applications. Well-known entities such as Thomson Reuters have HIPAA-compliant records-sharing systems that port patient information from data silos inside the hospital firewall to a physician’s mobile device. Or, in the case of Good Shepherd Health System in Longview, Texas, hospitals are developing their own clinical data management software for the iPhone and other devices.

Seeing health care information quickly, securely

Will the iPad penetrate health care, succeeding where other tablets haven’t?

With their touch-screens and light weight, tablet PCs, it seems, would be ideally suited for health care practitioners who currently tote unwieldy laptops and clipboards for clinical data entry.

Traditional laptops are heavy, and distract from the face-to-face, practitioner-to-patient interaction so much that Good Shepherd Health System CIO Mark Moffitt sees doctors and nurses write things down on paper and enter the data into electronic systems later, after the patient leaves.

However, tablets haven’t seen widespread adoption because their price point, typically above $2,000 per device, is “not very realistic for health care,” Moffitt said.

In addition, when doctors and nurses do use the devices, they need keyboards. Typing information into clinical data management software is too complicated for the touch-and-select operations that work so fast on tablet touch-screens.

Apple’s iPad, announced Jan. 27 and retailing for $499 to $829, depending on configuration, may make some inroads into health care, Moffitt said, because its “price point is right on” and because it runs the iPhone operating system, making it compatible with current iPhone apps proliferating in health care.

The iPad, which isn’t shipping until April, and most of its tablet-PC brethren have connections for keyboards. But the idea of carrying a tablet and a full-sized keyboard probably won’t make them any more appealing than laptops already are. -- D.F.

Good Shepherd’s iPhone app gives doctors access to a host of clinical data, including lab and blood bank reports, radiology information, medical histories and cardiology reports. In some cases, such as accessing verbal radiology reports, the iPhone offers doctors near instant access, when previously it took time and multiple steps to get those reads.

Good Shepherd decided to write its own iPhone app, CIO Mark Moffitt said, because the hospital couldn’t afford to license a ready-made application. Besides, as Moffitt wrote in his article on the HIStalk website, "iPhone for Clinical Data: A Different Approach," out-of-the-box systems require much more training and longer implementation curves, compared with applications customized to a facility’s existing workflow. For Good Shepherd, that customization includes playback of radiology dictation, which doctors requested, and beefed-up security, which is administered by assigning each physician a PIN that, in turn, works only on one particular iPhone.

Moffitt said Good Shepherd standardized on the iPhone because it was the device of choice. Many doctors had iPhones for personal use already, and a program the hospital launched last year offered the physicians $200 toward the purchase of one. At this point, about 80 doctors use the iPhone app at the 425-bed acute-care hospital.

The user interface will work on other mobile devices, although Good Shepherd has not had much pushback on this point. “A few people … have said, ‘It’d be nice if we could play this on our Google device,’ but so far that hasn’t been an issue,” Moffitt said.

Paying for iPhones and their service plans would have been a budget-buster for the hospital to finance on its own, but doctors share the expense. They don’t balk at paying for the iPhone service plans out of their own pockets, Moffitt said, although some can’t abide the spotty coverage. Longview, a city of 75,000 about 120 miles east of Dallas, has good AT&T coverage; for those living outside the city limits, or for doctors without iPhones, the CIO developed a workaround: lending them hospital-owned, iPod Touch devices for when they’re on duty. The wireless-enabled iPods are roughly the same size and include the same touch-screen and OS and run the hospital’s clinical data management software.

Doctors struggle to input information

So far, Moffitt confines iPhone use to data access and has no immediate plans for porting data entry to the devices. He said he feels the iPod/iPhone OS works well because the app includes a lot of choice-selection and paging through data. There is little keyboard use. Moffitt said virtual keyboards such as the iPhone’s or tiny keys such as the BlackBerry’s do not lend themselves well to everyday health care work. For PIN entry, the application displays a custom virtual keypad based on familiar ATMs that’s much larger than what the iPhone has.

Ultimately, Moffitt said he thinks smartphones will cover “80% to 90% of the work [physicians] would do on a computer,” including dictation, order approval, accessing protocols and simple order entry. “It’s very nonintrusive. You can pull an iPhone out, talk to the patient and flip through it -- and it doesn’t get between you and the patient,” he said.

The remainder of that work, Moffitt said, will be done on a PC or workstation. It is not ideal, he said, but smartphones in general are just too small to be practical data entry devices.

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